Is systematic mandibular retention mandatory? A systematic review

Relapse in orthodontics, and particularly, mandibular anterior crowding is an unforeseeable phenomenon and a quite embarrassing situation for the orthodontist, as it may be interpreted by the patient as a treatment failure. Relapse may be inherent to various factors (periodontal, anatomical, muscular, occlusal, residual growth, third molars development…), which must be imperatively acknowledged in order to be managed during orthodontic treatment and therefore ensure an optimal control on the stability of the achieved final outcomes. The aim of this review was to determine, through a systematic analysis based on a Medline PubMed search, the scientific relevant factors involved in the relapse of mandibular anterior crowding.

A systematic research was performed based on an electronic search (between 2005 and December 2016) among various databases. The search was limited to the use of several specific search words expressed in two languages: English and French. Two investigators selected those meeting the exclusion/inclusion criteria.

Out of the 1055 references, only 19 studies met our inclusion criteria. The factors addressed by these studies are: extraction or non-extraction treatment, residual growth, facial divergence, periodontium, type of retainer, incisor morphology and quality of dental occlusion. Divergence in female patients, thin cortical bone and treatment using aligners were associated with a higher rate of mandibular anterior crowding relapse. However, due to the low level of evidence of the included studies, as well as the heterogeneity of protocols between the studies, it was not possible to determine factors truly involved in mandibular crowding relapse. Future reliable prospective studies are required to provide unbiased and quantifiable results.